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Osman AM, Ali AM, Sayed HA, Atta H, Ahmed S, Alieldin N, Abdelhamed MA, Saad K, Shibl A. Cognitive performance and brain volume among survivors of pediatric hematological malignancies: a case-control study. Clin Transl Oncol 2024:10.1007/s12094-024-03646-7. [PMID: 39133385 DOI: 10.1007/s12094-024-03646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Cognitive dysfunction may be one of the hazardous late effects among survivors of pediatric hematological malignancies. Our study aimed to explore cognitive performance and assess the global and regional brain volume changes in survivors of hematological malignancies. METHODS This case-control study was conducted on 68 survivors of hematological malignancies, with a median follow-up period of 2 years (ranging from 1 to 6.2 years). Stanford-Binet Test was used for cognitive assessment. A quantitative volumetric assessment of the brain was done using the NeuroQuant Brain Magnetic Resonance. Age and sex-matched 68 children were selected as a comparison group. RESULTS Cancer survivors showed significantly lower levels of IQ and their subtests than the control group. Global brain atrophy was observed in the majority of the survivors. Many risk factors significantly affected different IQ subtests, such as radiotherapy (RTH), high cumulative doses of methotrexate (MTX), and prednisone. At the same time, low white matter volume (WMV) was observed with higher cumulative doses of MTX and anthracyclines. CONCLUSIONS Hematological malignancies have a negative impact on cognition. Neurocognitive impairment and related brain changes were evident in those who received RTH, HDMTX, or high cumulative doses of steroids.
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Affiliation(s)
- Amira M Osman
- Department of Pediatric Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Amany M Ali
- Department of Pediatric Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Heba A Sayed
- Department of Pediatric Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Haisam Atta
- Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Shimaa Ahmed
- Department of Radiation Oncology and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Nelly Alieldin
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Abdelhamed
- Neuropsychiatric Department, and Neuroepidemiology Lab, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Pediatric Department, Faculty of Medicine, Assiut University Children's Hospital, Assiut University Campus, Assiut, 71111, Egypt.
| | - Azza Shibl
- Department of Pediatric Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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2
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Krüger J, Opfer R, Spies L, Hedderich D, Buchert R. Voxel-based morphometry in single subjects without a scanner-specific normal database using a convolutional neural network. Eur Radiol 2024; 34:3578-3587. [PMID: 37943313 PMCID: PMC11166757 DOI: 10.1007/s00330-023-10356-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Reliable detection of disease-specific atrophy in individual T1w-MRI by voxel-based morphometry (VBM) requires scanner-specific normal databases (NDB), which often are not available. The aim of this retrospective study was to design, train, and test a deep convolutional neural network (CNN) for single-subject VBM without the need for a NDB (CNN-VBM). MATERIALS AND METHODS The training dataset comprised 8945 T1w scans from 65 different scanners. The gold standard VBM maps were obtained by conventional VBM with a scanner-specific NDB for each of the 65 scanners. CNN-VBM was tested in an independent dataset comprising healthy controls (n = 37) and subjects with Alzheimer's disease (AD, n = 51) or frontotemporal lobar degeneration (FTLD, n = 30). A scanner-specific NDB for the generation of the gold standard VBM maps was available also for the test set. The technical performance of CNN-VBM was characterized by the Dice coefficient of CNN-VBM maps relative to VBM maps from scanner-specific VBM. For clinical testing, VBM maps were categorized visually according to the clinical diagnoses in the test set by two independent readers, separately for both VBM methods. RESULTS The VBM maps from CNN-VBM were similar to the scanner-specific VBM maps (median Dice coefficient 0.85, interquartile range [0.81, 0.90]). Overall accuracy of the visual categorization of the VBM maps for the detection of AD or FTLD was 89.8% for CNN-VBM and 89.0% for scanner-specific VBM. CONCLUSION CNN-VBM without NDB provides a similar performance in the detection of AD- and FTLD-specific atrophy as conventional VBM. CLINICAL RELEVANCE STATEMENT A deep convolutional neural network for voxel-based morphometry eliminates the need of scanner-specific normal databases without relevant performance loss and, therefore, could pave the way for the widespread clinical use of voxel-based morphometry to support the diagnosis of neurodegenerative diseases. KEY POINTS • The need of normal databases is a barrier for widespread use of voxel-based brain morphometry. • A convolutional neural network achieved a similar performance for detection of atrophy than conventional voxel-based morphometry. • Convolutional neural networks can pave the way for widespread clinical use of voxel-based morphometry.
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Affiliation(s)
| | | | | | - Dennis Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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3
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Li F, Guo Y, Xu G, Liu Y, Chen X, Zhang T. Changed cortical thickness and sulcal depth in pediatric acute lymphoblastic leukemia survivors treated with chemotherapy only. Brain Imaging Behav 2023; 17:738-748. [PMID: 37736832 DOI: 10.1007/s11682-023-00794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
The purpose of this study is to observe the changes of cortical morphological characteristics and their potential contribution to cognitive function in ALL survivors by using surface-based morphometry (SBM). Using SBM analysis, we calculated and compared group differences in cortical thickness, sulcal depth, gyrification, and fractal dimension of the cerebral cortex between 18 pediatric ALL survivors treated on chemotherapy-only protocols and off treatment within 2 years, and 18 healthy controls (HCs) with two-sample t-tests [P < 0.05, family-wise error (FWE) corrected]. Relationships between abnormal cortical characteristic values and cognitive function parameters were investigated with partial correlation analysis, taking age as a covariate. We found decreased cortical thickness mainly located in the prefrontal and temporal region, and increased sulcal depth in left rostral middle frontal cortex and left pars orbitalis in the ALL survivors compared to HCs. There were no statistically significant differences in the gyrification and fractal dimension between the two groups. In ALL survivors, cortical thickness and sulcal depth of above areas values revealed no significant correlation with the cognitive function parameters. In conclusion, pediatric ALL survivors show decreased cortical thickness in prefrontal and temporal regions, and increased sulcal depth in prefrontal region. These results suggest that SBM-based approach can be used to assess changes of cortical morphological characteristics in pediatric ALL survivors.
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Affiliation(s)
- Fangling Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, People's Republic of China
| | - Yimin Guo
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People's Republic of China
- Department of Pediatrics, Guizhou Chlidren's Hospital, Zunyi, Guizhou Province, 563000, People's Republic of China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People's Republic of China
| | - Gaoqiang Xu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, People's Republic of China
| | - Ying Liu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People's Republic of China
- Department of Pediatrics, Guizhou Chlidren's Hospital, Zunyi, Guizhou Province, 563000, People's Republic of China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People's Republic of China
| | - Xiaoxi Chen
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, People's Republic of China.
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, People's Republic of China.
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4
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Kim JB, Lee JM, Son SM. Childhood Acute Lymphoblastic Leukemia Showing Unilateral Motor Dysfunction Prior to Chemotherapy: A Diffusion Tensor Tractography Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020224. [PMID: 36832353 PMCID: PMC9954999 DOI: 10.3390/children10020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
This study aimed to evaluate children with lymphoblastic leukemia and examine the potential correlation between corticospinal tract (CST) injury and motor dysfunction prior to chemotherapy using diffusion tensor tractography (DTT). Nineteen consecutive patients with childhood leukemia (mean age 7.483 ± 3.1 years, range 4-12 years) with unilateral motor dysfunction who underwent DTT prior to chemotherapy and twenty healthy individuals (mean age 7.478 ± 1.2 years; range 4-12 years) were enrolled. Motor functions were evaluated by two independent investigators. The cause of neurological dysfunction was identified based on the CST state using mean fractional anisotropy (FA), mean fiber volume (FV), and CST integrity using DTT. All patients showed disrupted integrity and significantly decreased FA and FV in the affected CST compared to the unaffected CST and the control group (p < 0.05). These DTT results also corresponded to patients' unilateral motor dysfunction. Using DTT, we demonstrated that neurological dysfunction may occur in patients with childhood acute lymphoblastic leukemia even prior to chemotherapy, and that CST injuries correlate with motor dysfunction in these patients. DTT may be a useful modality for evaluating the neural tract state in pediatric leukemia patients with neurological dysfunction.
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Affiliation(s)
- Jong Bum Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Jae Min Lee
- Department of Pediatric Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Su Min Son
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
- Correspondence: ; Tel.: +82-53-620-3268
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5
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Cranial MRI in Childhood Acute Leukemia during Treatment and Follow-Up Including the Impact of Intrathecal MTX-A Single-Center Study and Review of the Literature. Cancers (Basel) 2022; 14:cancers14194688. [PMID: 36230611 PMCID: PMC9563423 DOI: 10.3390/cancers14194688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
Due to high survival rates, long-term sequelae, especially neurotoxicity, need to be considered in childhood acute leukemias. In this retrospective analysis of morphologic changes of the brain in children treated for acute leukemias, we included 94 patients (77 ALL, 17 AML; 51 male, 43 female; median age: 5 years) from a single center. We analyzed 170 cranial MRI scans (T2, FLAIR axial) for morphologic alterations of the brain and variations of the ventricular width (GDAH). In addition, the corresponding literature was reviewed. More than 50% of all patients showed cerebral pathomorphologies (CP). They were seen more often in children with ALL (55.8%), ≤ 6 years of age (60.8%), in relapse (58.8%) or after CNS irradiation (75.0%) and included white matter changes, brain atrophy, sinus vein thrombosis and ischemic events. GDAH significantly enlarged mainly in children up to 6 years, with relapse, high-risk leukemias or ALL patients. However, GDAH can normalize again. The number of intrathecal Methotrexate applications (≤12 vs. >12) showed no correlation to morphologic alterations besides a significant increase in GDAH (−0.3 vs. 0.9 mm) between the first and last follow-up MRI in ALL patients receiving >12 ith. MTX applications. The role of ith. MTX on CP needs to be further investigated and correlated to the neurocognitive outcome of children with acute leukemias.
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6
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Wurz A, Ayson G, Smith AM, Brunet J. A proof-of-concept sub-study exploring feasibility and preliminary evidence for the role of physical activity on neural activity during executive functioning tasks among young adults after cancer treatment. BMC Neurol 2021; 21:300. [PMID: 34344355 PMCID: PMC8336393 DOI: 10.1186/s12883-021-02280-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Executive functioning (EF) deficits are troubling for adolescents and young adults (AYAs) after cancer treatment. Physical activity (PA) may enhance neural activity underlying EF among older adults affected by cancer. Establishing whether PA enhances neural activity among AYAs is warranted. As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this proof-of-concept sub-study sought to answer the following questions: (1) is it feasible to use neuroimaging with EF tasks to assess neural activity changes following a 12-week PA intervention? And (2) is there preliminary evidence that a 12-week PA intervention enhances neural activity among AYAs after cancer treatment? Methods AYAs in the pilot RCT were approached for enrollment into this sub-study. Those who were eligible and enrolled, completed functional magnetic resonance imaging (fMRI) with EF tasks (letter n-back, Go/No Go) pre- and post-PA intervention. Sub-study enrollment, adherence to scheduled fMRI scans, outliers, missing data, and EF task performance data were collected. Data were analyzed with descriptive statistics, blood oxygen level dependent (BOLD) analyses, and paired sample t-tests. Results Nine eligible participants enrolled into this sub-study; six attended scheduled fMRI scans. One outlier was identified and was subsequently removed from the analytical sample. Participants showed no differences in EF task performance from pre- to post-PA intervention. Increases in neural activity in brain regions responsible for motor control, information encoding and processing, and decision-making were observed post-PA intervention (p < 0.05; n = 5). Conclusions Findings show that fMRI scans during EF tasks detected neural activity changes (as assessed by the BOLD signal) from pre- to post-PA intervention. Results thus suggest future trials confirming that PA enhances neural activity underlying EF are needed, though feasibility issues require careful consideration to ensure trial success. Trial registration clinicaltrials.gov, NCT03016728. Registered January 11, 2017, clinicaltrials.gov/ct2/show/NCT03016728. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02280-y.
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Affiliation(s)
- Amanda Wurz
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada.,Present affiliation: Faculty of Kinesiology, University of Calgary, Alberta, Calgary, Canada
| | - Gladys Ayson
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada. .,Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. .,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.
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7
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Spitzhüttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Schmidt M, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Steinlin M, Roebers CM, Leibundgut K, Everts R. Cortical Morphometry and Its Relationship with Cognitive Functions in Children after non-CNS Cancer. Dev Neurorehabil 2021; 24:266-275. [PMID: 33724900 DOI: 10.1080/17518423.2021.1898059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Childhood cancer survivors (Ccs) are at risk for cognitive late-effects, which might result from cortical alterations, even if cancer does not affect the brain. The study aimed to examine gray and white matter volume and its relationship to cognition. Methods: Forty-three Ccs of non-central nervous system cancers and 43 healthy controls, aged 7-16 years, were examined. Cognitive functions and fine motor coordination were assessed and T1-weighted images were collected for voxel-based morphometry. Results: Executive functions (p = .024, d = .31) were poorer in Ccs than controls, however still within the normal range. The volume of the amygdala (p = .011, ŋ2 = .117) and the striatum (p = .03, ŋ2 = .102) was reduced in Ccs. No significant structure-function correlations were found, neither in patients nor controls. Conclusion: Non-CNS childhood cancer and its treatment impacts on brain structures relevant to emotion processing.
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Affiliation(s)
- Janine S Spitzhüttl
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria.,Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria.,Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Valentin Benzing
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Department of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | | | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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8
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Sleurs C, Blommaert J, Batalle D, Verly M, Sunaert S, Peeters R, Lemiere J, Uyttebroeck A, Deprez S. Cortical thinning and altered functional brain coherence in survivors of childhood sarcoma. Brain Imaging Behav 2021; 15:677-688. [PMID: 32335825 DOI: 10.1007/s11682-020-00276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
High-dose chemotherapy is increasingly evidenced to be neurotoxic and result in long-term neurocognitive sequelae. However, research investigating grey matter alterations in childhood cancer patients remains limited. As childhood sarcoma patients receive high-dose chemotherapy, we aimed to investigate cortical brain alterations in adult survivors. We analyzed high-resolution structural (T1-weighted) MRI and resting-state functional MRI (rsfMRI), to derive structural and functional cortical information in survivors of childhood sarcoma, treated with high-dose intravenous chemotherapy (n = 33). These scans were compared to age- and gender- matched controls (n = 34). Cortical volume and thickness were investigated using voxel-based morphometry and vertex-wise surface-based morphometry. Brain regions showing significant group differences in volume or thickness were implemented as seeds of interest to estimate their resting state co-activity with other areas (i.e. functional coherence). We explored whether structural measures were associated with potential risk factors, such as age at diagnosis, and cumulative doses of chemotherapeutic agents (methotrexate, ifosfamide). Finally, we investigated the link between functional regional strength, neurocognitive assessments and daily life complaints. In patients relative to controls we observed lower grey matter volumes in cerebellar and frontal areas, as well as frontal cortical thinning. Cerebellar volume and orbitofrontal thickness appeared dose- and age-related, respectively. Cortical thickness of the parahippocampal area appeared lower, only if the group comparison was not adjusted for depression. This region specifically showed lower functional coherence, which was associated with lower processing speed. This study suggests cortical thinning as well as decreased functional coherence in survivors of childhood sarcoma, which could be important for both long-term attentional functioning and emotional distress in daily life. Frontal areas might be specifically vulnerable during adolescence.
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Affiliation(s)
| | | | - Dafnis Batalle
- Department of Forensic & Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marjolein Verly
- Department of Neurosciences, ExpORL, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ron Peeters
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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9
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Zhou C, Zhuang Y, Lin X, Michelson AD, Zhang A. Changes in neurocognitive function and central nervous system structure in childhood acute lymphoblastic leukaemia survivors after treatment: a meta-analysis. Br J Haematol 2019; 188:945-961. [PMID: 31823355 DOI: 10.1111/bjh.16279] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/18/2019] [Indexed: 12/25/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children. Although the survival rate has increased dramatically over the last decades, patients struggle with the adverse side effects of treatment. Treatment for ALL includes chemotherapy and irradiation - both of which are linked to cognitive impairments and alterations in central nervous system (CNS) structure and function detected by neuroimaging and in neurocognitive studies. The present article is a meta-analysis of the existing evidence for the mechanisms underlying changes in the CNS and neurocognitive function in ALL survivors after treatment. We found that compared with controls, ALL survivors develop: (i) cognitive sequelae in intelligence, academics, attention, memory, processing speed and executive function domains; (ii) decreased grey and white matter volume in cortical and several subcortical brain regions, with functional changes particularly in frontal regions and the hippocampus; (iii) neurocognitive impairments related to CNS changes; and (iv) reduction, but not resolution, of late neurocognitive sequelae in patients in whom prophylactic irradiation was replaced by systemic/intrathecal chemotherapy. Continued work with advanced functional magnetic resonance imaging techniques will hopefully allow the detection of early CNS changes as biomarkers to help guide early diagnosis and intervention for neurocognitive defects in patients with childhood ALL.
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Affiliation(s)
- Chendan Zhou
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yong Zhuang
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xingjie Lin
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Alan D Michelson
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Aijun Zhang
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, Shandong, China.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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10
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Al-Fahad R, Yeasin M, Glass JO, Conklin HM, Jacola LM, Reddick WE. Early Imaging Based Predictive Modeling of Cognitive Performance Following Therapy for Childhood ALL. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2019; 7:146662-146674. [PMID: 32547892 PMCID: PMC7297193 DOI: 10.1109/access.2019.2946240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the United States, Acute Lymphoblastic Leukemia (ALL), the most common child and adolescent malignancy, accounts for roughly 25% of childhood cancers diagnosed annually with a 5-year survival rate as high as 94% [1]. This improved survival rate comes with an increased risk for delayed neurocognitive effects in attention, working memory, and processing speed [2]. Predictive modeling and characterization of neurocognitive effects are critical to inform the family and also to identify patients for interventions targeting. Current state-of-the-art methods mainly use hypothesis-driven statistical testing methods to characterize and model such cognitive events. While these techniques have proven to be useful in understanding cognitive abilities, they are inadequate in explaining causal relationships, as well as individuality and variations. In this study, we developed multivariate data-driven models to measure the late neurocognitive effects of ALL patients using behavioral phenotypes, Diffusion Tensor Magnetic Resonance Imaging (DTI) based tractography data, morphometry statistics, tractography measures, behavioral, and demographic variables. Alongside conventional machine learning and graph mining, we adopted "Stability Selection" to select the most relevant features and choose models that are consistent over a range of parameters. The proposed approach demonstrated substantially improved accuracy (13% - 26%) over existing models and also yielded relevant features that were verified by domain experts.
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Affiliation(s)
| | | | - John O. Glass
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Lisa M. Jacola
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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11
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Boulet‐Craig A, Robaey P, Barlaam F, Laniel J, Oswald V, Jerbi K, Sultan S, Affret‐Bertout L, Drouin S, Krajinovic M, Laverdière C, Sinnett D, Jolicoeur P, Lippé S. Visual short‐term memory activation patterns in adult survivors of childhood acute lymphoblastic leukemia. Cancer 2019; 125:3639-3648. [DOI: 10.1002/cncr.32374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Aubree Boulet‐Craig
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Philippe Robaey
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
- Department of Psychiatry University of Montreal Montreal Quebec Canada
- Department of Psychiatry University of Ottawa Ottawa Ontario Canada
- Children's Hospital of Eastern Ontario Ottawa Ontario Canada
| | - Fanny Barlaam
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Julie Laniel
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Victor Oswald
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Karim Jerbi
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Serge Sultan
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | | | - Simon Drouin
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Maja Krajinovic
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Caroline Laverdière
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Daniel Sinnett
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Pierre Jolicoeur
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Sarah Lippé
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
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12
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Billiet T, Elens I, Sleurs C, Uyttebroeck A, D'Hooge R, Lemiere J, Deprez S. Brain Connectivity and Cognitive Flexibility in Nonirradiated Adult Survivors of Childhood Leukemia. J Natl Cancer Inst 2019. [PMID: 29514304 DOI: 10.1093/jnci/djy009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background This study aimed to assess functional and structural brain connectivity in adult childhood leukemia survivors and the link with cognitive functioning and previously identified risk factors such as intrathecal methotrexate dose and age at start of therapy. Methods Thirty-one nonirradiated adult childhood leukemia survivors and 35 controls underwent cognitive testing and multimodal magnetic resonance imaging (resting state functional MRI, T1-weighted, diffusion-weighted, and myelin water imaging [MWI]). Analyses included dual regression, voxel-based morphometry, advanced diffusion, and MWI modeling techniques besides stepwise discriminant function analysis to identify the most affected executive cognitive domain. Correlations with discrete intrathecal MTX doses and (semi)continuous variables were calculated using Spearman's rank and Pearson's correlation, respectively. All correlation tests were two-sided. Positive and negative T-contrasts in functional and structural MRI analysis were one-sided. Results Survivors demonstrated lower functional connectivity between the default mode network (DMN) and inferior temporal gyrus (ITG; P < .008). Additionally, we observed higher fractional anisotropy (FA; P = .04) and lower orientation dispersion index (ODI; P = .008) at the left centrum semiovale, which could-given that several fiber bundles cross this region-suggest selective reduced integrity of the respective white matter tracts. Set shifting reaction time, a measure of cognitive flexibility, was mostly impaired and correlated with lower FA (r = -0.53, P = .003) and higher ODI (r = 0.40, P = .04) in survivors but not with DMN-ITG connectivity. There were no statistically significant differences between survivors and controls in WM or GM volume, nor was there a statistically significant correlation between imaging measurements and age at start of therapy or intrathecal methotrexate dose. Conclusions Adult, nonirradiated childhood leukemia survivors show altered brain connectivity, which is linked with cognitive flexibility.
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Affiliation(s)
- Thibo Billiet
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Icometrix, Leuven, Belgium
| | - Iris Elens
- Department of Child and Adolescent Psychiatry, KU Leuven, University Psychiatric Centre Leuven, Leuven, Belgium.,Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Charlotte Sleurs
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Department of Pediatrics, Pediatric Hemato-Oncology, KU Leuven, University Hospital Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatrics, Pediatric Hemato-Oncology, KU Leuven, University Hospital Leuven, Leuven, Belgium
| | - Rudi D'Hooge
- Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatrics, Pediatric Hemato-Oncology, KU Leuven, University Hospital Leuven, Leuven, Belgium
| | - Sabine Deprez
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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13
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Zhang Y, Yi X, Gao J, Li L, Liu L, Qiu T, Zhang J, Zhang Y, Liao W. Chemotherapy Potentially Facilitates the Occurrence of Radiation Encephalopathy in Patients With Nasopharyngeal Carcinoma Following Radiotherapy: A Multiparametric Magnetic Resonance Imaging Study. Front Oncol 2019; 9:567. [PMID: 31334108 PMCID: PMC6618298 DOI: 10.3389/fonc.2019.00567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Radiation encephalopathy (RE) is deemed to be a disease induced only by radiotherapy (RT), with the effects of chemotherapeutic agents on the brains of nasopharyngeal carcinoma (NPC) patients being largely overlooked. In this study, we investigated structural and functional brain alterations in NPC patients following RT with or without chemotherapy. Fifty-six pre-RT, 37 post-RT, and 108 post-CCRT (concomitant chemo-radiotherapy) NPC patients were enrolled in this study. A surface-based local gyrification index (LGI) was obtained from high resolution MRI and was used to evaluate between-group differences in cortical folding. Seed-based functional connectivity (FC) analysis of resting-state fMRI data was also conducted to investigate the functional significance of the cortical folding alterations. Compared with the Pre-RT group, patients in the Post-CCRT group showed LGI reductions in widespread brain regions including the bilateral temporal lobes, insula, frontal lobes, and parietal lobes. Compared with the Post-RT group, patients in the Post-CCRT group showed LGI reductions in the right insula, which extended to the adjacent frontal lobe. Seed-based FC analysis showed that patients in the Post-CCRT group had lower FC between the insula and the left middle frontal gyrus than patients in the Pre-RT group. The follow-up results showed that patients in the Post-CCRT group had a much higher RE incidence rate (20.4%) than patients in the Post-RT group (2.7%; P = 0.01). These findings indicate that chemotherapy potentially facilitated the occurrence of RE in NPC patients who underwent radiotherapy.
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Affiliation(s)
- Youming Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jianming Gao
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging Diagnosis and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lizhi Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging Diagnosis and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ting Qiu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinlei Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanchao Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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14
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Darling S, De Luca CR, Anderson V, McCarthy M, Hearps S, Seal M. Brain morphology and information processing at the completion of chemotherapy-only treatment for pediatric acute lymphoblastic leukemia. Dev Neurorehabil 2019; 22:293-302. [PMID: 29969366 DOI: 10.1080/17518423.2018.1492988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Approximately 50% of survivors of childhood acute lymphoblastic leukemia (ALL) demonstrate cognitive impairments. However, the trajectory of change and contributing neuropathology is unclear, limiting our ability to tailor intervention content and timing. This study aimed to explore information processing abilities and brain morphology early post-treatment for pediatric ALL. Procedure: Twenty-one children at the end of ALL treatment and 18 controls underwent neuropsychological assessment. A subset also completed structural magnetic resonance imaging. Results: A principal component analysis generated two cognitive factors: information processing capacity and information processing speed. Compared to control group, the ALL group displayed deficits in capacity, but not speed. No group differences were identified in morphology. No relationship was identified between capacity or speed and morphology. Conclusion: Early cognitive intervention should target information processing abilities using a system-wide approach. Future studies should employ alternative imaging techniques sensitive to white-matter microstructure when exploring pathology underlying information processing deficits.
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Affiliation(s)
- Simone Darling
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia.,b Department of Paediatrics , University of Melbourne , Melbourne , Australia
| | - Cinzia Rachele De Luca
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia.,c Children's Cancer Centre , The Royal Children's Hospital , Melbourne , Australia
| | - Vicki Anderson
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia.,b Department of Paediatrics , University of Melbourne , Melbourne , Australia.,d Psychology Department , The Royal Children's Hospital , Melbourne , Australia
| | - Maria McCarthy
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia.,c Children's Cancer Centre , The Royal Children's Hospital , Melbourne , Australia
| | - Stephen Hearps
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia
| | - Marc Seal
- a Clinical Sciences , Murdoch Children's Research Institute , Parkville , Australia.,b Department of Paediatrics , University of Melbourne , Melbourne , Australia
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15
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Nagtegaal SHJ, David S, van der Boog ATJ, Leemans A, Verhoeff JJC. Changes in cortical thickness and volume after cranial radiation treatment: A systematic review. Radiother Oncol 2019; 135:33-42. [PMID: 31015168 DOI: 10.1016/j.radonc.2019.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
Cognitive decline has a clear impact on quality of life in patients who have received cranial radiation treatment. The pathophysiological process is most likely multifactorial, with a possible role for decreased cortical thickness and volume. As radiotherapy treatment systems are becoming more sophisticated, precise sparing of vulnerable regions and tissue is possible. This allows radiation oncologists to make treatment more patient-tailored. A systematic search was performed to collect and review all available evidence regarding the effect of cranial radiation treatment on cortical thickness and volume. We searched the Pubmed, Embase and Cochrane databases, with an additional reference check in the Scopus database. Studies that examined cortical changes on MRI within patients as well as between treated and non-treated patients were included. The quality of the studies was assessed with a checklist specially designed for this review. No meta-analysis was performed due to the lack of randomised trials. Out of 1915 publications twenty-one papers were selected, of which fifteen observed cortical changes after radiation therapy. Two papers reported radiation-dependent decrease in cortical thickness within patients one year after radiation treatment, suggesting a clear relation between the two. However, study quality was considered mostly suboptimal, and there was great inhomogeneity between the included studies. This means that, although there has been increasing interest in the effects of radiation treatment on cortex morphology, no reliable conclusion can be drawn based on the currently available evidence. This calls for more research, preferably with a sufficiently large patient population, and adequate methodology.
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Affiliation(s)
- Steven H J Nagtegaal
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Szabolcs David
- Image Sciences Institute, University Medical Center, Utrecht, the Netherlands.
| | | | - Alexander Leemans
- Image Sciences Institute, University Medical Center, Utrecht, the Netherlands.
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands.
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16
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Sabin ND, Cheung YT, Reddick WE, Bhojwani D, Liu W, Glass JO, Brinkman TM, Hwang SN, Srivastava D, Pui CH, Robison LL, Hudson MM, Krull KR. The Impact of Persistent Leukoencephalopathy on Brain White Matter Microstructure in Long-Term Survivors of Acute Lymphoblastic Leukemia Treated with Chemotherapy Only. AJNR Am J Neuroradiol 2018; 39:1919-1925. [PMID: 30213807 DOI: 10.3174/ajnr.a5791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Survivors of acute lymphoblastic leukemia are at risk for neurocognitive deficits and leukoencephalopathy. We performed a longitudinal assessment of leukoencephalopathy and its associations with long-term brain microstructural white matter integrity and neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia treated on a modern chemotherapy-only protocol. MATERIALS AND METHODS One hundred seventy-three survivors of acute lymphoblastic leukemia (49% female), treated on a chemotherapy-only protocol, underwent brain MR imaging during active therapy and repeat imaging and neurocognitive testing at follow-up (median, 13.5 years of age; interquartile range, 10.7-17.6 years; median time since diagnosis, 7.5 years; interquartile range, 6.3-9.1 years). Persistence of leukoencephalopathy was examined in relation to demographic and treatment data and to brain DTI in major fiber tracts and neurocognitive testing at follow-up. RESULTS Leukoencephalopathy was found in 52 of 173 long-term survivors (30.0%) and persisted in 41 of 52 (78.8%) who developed it during therapy. DTI parameters were associated with leukoencephalopathy in multiple brain regions, including the corona radiata (fractional anisotropy, P = .001; mean diffusivity, P < .001), superior longitudinal fasciculi (fractional anisotropy, P = .02; mean diffusivity, P < .001), and superior fronto-occipital fasciculi (fractional anisotropy, P = .006; mean diffusivity, P < .001). Mean diffusivity was associated with neurocognitive impairment including in the genu of the corpus callosum (P = .04), corona radiata (P = .02), and superior fronto-occipital fasciculi (P = .02). CONCLUSIONS Leukoencephalopathy during active therapy and neurocognitive impairment at long-term follow-up are associated with microstructural white matter integrity. DTI may be more sensitive than standard MR imaging for detection of clinically consequential white matter abnormalities in childhood acute lymphoblastic leukemia survivors treated with chemotherapy and in children undergoing treatment.
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Affiliation(s)
- N D Sabin
- From the Departments of Diagnostic Imaging (N.D.S., W.E.R., J.O.G., S.N.H.)
| | - Y T Cheung
- Epidemiology and Cancer Control (Y.T.C., T.M.B., L.L.R., M.M.H., K.R.K.)
| | - W E Reddick
- From the Departments of Diagnostic Imaging (N.D.S., W.E.R., J.O.G., S.N.H.)
| | - D Bhojwani
- Children's Center for Cancer and Blood Diseases (D.B.), Children's Hospital Los Angeles, Los Angeles, California
| | - W Liu
- Biostatistics (W.L., D.S.)
| | - J O Glass
- From the Departments of Diagnostic Imaging (N.D.S., W.E.R., J.O.G., S.N.H.)
| | - T M Brinkman
- Epidemiology and Cancer Control (Y.T.C., T.M.B., L.L.R., M.M.H., K.R.K.)
- Psychology (T.M.B., K.R.K.)
| | - S N Hwang
- From the Departments of Diagnostic Imaging (N.D.S., W.E.R., J.O.G., S.N.H.)
| | | | - C-H Pui
- Oncology (C.-H.P., M.M.H.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - L L Robison
- Epidemiology and Cancer Control (Y.T.C., T.M.B., L.L.R., M.M.H., K.R.K.)
| | - M M Hudson
- Epidemiology and Cancer Control (Y.T.C., T.M.B., L.L.R., M.M.H., K.R.K.)
- Oncology (C.-H.P., M.M.H.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - K R Krull
- Epidemiology and Cancer Control (Y.T.C., T.M.B., L.L.R., M.M.H., K.R.K.)
- Psychology (T.M.B., K.R.K.)
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17
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Marusak HA, Iadipaolo AS, Harper FW, Elrahal F, Taub JW, Goldberg E, Rabinak CA. Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes. Neuropsychol Rev 2018; 28:123-175. [PMID: 29270773 PMCID: PMC6639713 DOI: 10.1007/s11065-017-9365-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine's true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent "cure" that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer - namely, the presence of a life-threatening disease and endurance of invasive medical procedures - has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA.
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Felicity W Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Elimelech Goldberg
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Kids Kicking Cancer, Southfield, MI, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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18
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Alias H, Lau SCD, Schuitema I, de Sonneville LMJ. Neuropsychological Consequences for Survivors of Childhood Brain Tumor in Malaysia. Front Psychol 2018; 9:703. [PMID: 29896137 PMCID: PMC5986920 DOI: 10.3389/fpsyg.2018.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023] Open
Abstract
Objective: This study aimed to evaluate neuropsychological consequences in survivors of childhood brain tumor. Method: A case-control study was conducted over a period of 4 months in a tertiary referral center in Kuala Lumpur, Malaysia. Fourteen survivors of childhood brain tumor aged 7–18 years, who were off-treatment for at least 1 year and were in remission, and 31 unrelated healthy controls were recruited. The median age at diagnosis was 8.20 years (range: 0.92–12.96 years). The diagnoses of brain tumors were medulloblastoma, germ cell tumor, pineocytoma, pilocystic astrocytoma, suprasellar germinoma, and ependymoma. Eleven survivors received central nervous system irradiation. Seven tasks were selected from the Amsterdam Neuropsychological Tasks program to evaluate alertness (processing speed), and major aspects of executive functioning, such as working memory capacity, inhibition, cognitive flexibility, and sustained attention. Speed, stability and accuracy of responses were the main outcome measures. Results: Survivors of childhood brain tumor showed statistically significant poorer performance on all tasks compared to healthy controls. Both processing speed and accuracy were impaired in the survivors, in particular under more complex task conditions. The survivors demonstrated deficits in alertness, sustained attention, working memory capacity, executive visuomotor control, and cognitive flexibility. Longer duration off treatment appeared to be correlated with poorer alertness, memory capacity, and inhibition. Conclusion: Survivors of childhood brain tumor in our center showed impaired neuropsychological functioning. Development of less toxic treatment protocols is important to prevent late effects of cognitive deficits in survivors of childhood brain tumor.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Sie Chong D Lau
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Ilse Schuitema
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - Leo M J de Sonneville
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
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19
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Zając-Spychała O, Pawlak M, Karmelita-Katulska K, Pilarczyk J, Jończyk-Potoczna K, Przepióra A, Derwich K, Wachowiak J. Anti-leukemic treatment-induced neurotoxicity in long-term survivors of childhood acute lymphoblastic leukemia: impact of reduced central nervous system radiotherapy and intermediate- to high-dose methotrexate. Leuk Lymphoma 2018; 59:2342-2351. [PMID: 29424258 DOI: 10.1080/10428194.2018.1434879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of the study was to evaluate the long-term neurodevelopmental consequences of currently applied acute lymphoblastic leukemia (ALL) therapy containing chemotherapy alone or combined with 12 Gy radiotherapy. Seventy-nine children aged 6.3-21.7 years diagnosed with ALL and treated according to ALL IC-BFM 2002 have been studied. The control group consisted of 23 children newly diagnosed with ALL. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between three therapeutic schemes and patients prior to treatment. Irradiated patients had smaller selected subcortical volumes than those treated with chemotherapy alone and than the controls, while the chemotherapy group had similar volumes as the control one. In neurocognitive assessment, irradiated children performed worse in major domains than the control group. There were no significant results for patients after high dose chemotherapy without radiotherapy. There was a significant relationship between full scale IQ together with verbal learning and volumes of hippocampus, amygdala, and pallidum. In all children treated for ALL, both decreased volume of selected subcortical structures and cognitive impairment were observed, especially in children who were irradiated.
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Affiliation(s)
- Olga Zając-Spychała
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Mikolaj Pawlak
- b Department of Neurology and Cerebrovascular Disorders , Poznan University of Medical Sciences , Poznan , Poland
| | | | - Jakub Pilarczyk
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | | | - Agnieszka Przepióra
- d Department of Pediatric Radiology , Poznan University of Medical Sciences , Poznan , Poland
| | - Katarzyna Derwich
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Jacek Wachowiak
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
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20
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Zou L, Su L, Xu J, Xiang L, Wang L, Zhai Z, Zheng S. Structural brain alteration in survivors of acute lymphoblastic leukemia with chemotherapy treatment: A voxel-based morphometry and diffusion tensor imaging study. Brain Res 2017; 1658:68-72. [DOI: 10.1016/j.brainres.2017.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/21/2016] [Accepted: 01/14/2017] [Indexed: 11/26/2022]
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21
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Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet Oncol 2017; 18:e91-e100. [DOI: 10.1016/s1470-2045(17)30030-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023]
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Long-term brain structural magnetic resonance imaging and cognitive functioning in children treated for acute lymphoblastic leukemia with high-dose methotrexate chemotherapy alone or combined with CNS radiotherapy at reduced total dose to 12 Gy. Neuroradiology 2017; 59:147-156. [PMID: 28074235 PMCID: PMC5371615 DOI: 10.1007/s00234-016-1777-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/14/2016] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to assess the long-term side effects of central nervous system prophylaxis (high-dose chemotherapy alone vs chemotherapy and CNS radiotherapy) according to the ALL IC-BFM 2002. METHODS Thirty-tree children aged 6.7-19.9 years have been studied. The control group consisted of 12 children newly diagnosed with acute lymphoblastic leukemia. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between two therapeutic schemes and patients prior to treatment. RESULTS Patients treated with chemotherapy and CNS radiotherapy had smaller hippocampi than two other subgroups and lower IQ score than patients treated with chemotherapy alone. Both treated groups, whether with chemotherapy only or in combination with CNS radiotherapy, had significantly lower volumes of caudate nucleus and performed significantly worse on measures of verbal fluency in comparison with patients prior to treatment. There were no differences in the mean volumes of total white matter, total gray matter, thalamus, putamen, and amygdala between the studied groups. CONCLUSION In all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment was observed, especially in children who received chemotherapy in combination with reduced dose CNS radiotherapy. In all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment were observed, especially in children who received chemotherapy in combination with CNS radiotherapy.
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23
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Follin C, Erfurth EM, Johansson A, Lätt J, Sundgren PC, Österberg K, Spulber G, Mannfolk P, Björkman-Burtscher IM. Impaired brain metabolism and neurocognitive function in childhood leukemia survivors despite complete hormone supplementation in adulthood. Psychoneuroendocrinology 2016; 73:157-165. [PMID: 27498291 DOI: 10.1016/j.psyneuen.2016.07.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
Cranial radiotherapy is a known risk factor for neurocognitive impairment in survivors of childhood acute lymphoblastic leukemia (ALL). Understanding the nature of cognitive dysfunction during adulthood in ALL survivors is important as it has an impact on major life situations. Thirty-eight (21 women) ALL survivors were investigated 34 years after diagnosis. Median-age was 38 (27-46) years. All were treated with a CRT dose of 24Gy and 11 years (3-13) of complete hormone supplementation. Comparisons were made to 29 matched controls. Assessments of magnetic resonance spectroscopy (white and grey matter metabolic alterations), brain volume and neuropsychological tests were performed. ALL survivors demonstrate a generally lower performance in neuropsychological tests. ALL survivors scored lower than controls in vocabulary (p<0.001), memory (p<0.001), learning capacity (p<0.001), spatial ability (p<0.001), executive functions and attention (p<0.001) 34 years after ALL treatment. Compared to controls ALL survivors had reduced white matter (WM) (492 vs 536cm3, p<0.001) and grey matter (GM) volumes (525 vs 555cm3, p=0.001). ALL survivors had lower levels of WM N-acetyl aspartate/creatin (NAA/Cr) (1.48 vs 1.63, p=0.004), WM NAA+NAAG (N-acetylaspartylglutamate)/Cr (1.61 vs 1.85, p<0.001) and lower levels of GM NAA/Cr (1.18 vs 1.30, p=0.001) and GM NAA+NAAG/Cr (1.28 vs 1.34, p=0.01) compared to controls. ALL survivors had higher levels in WM MI (Myoinositol)/NAA (0.65 vs 0.56, p=0.01) concentrations compared to controls. There was a significantly negative correlation of years since ALL diagnosis to WM NAA+NAAG/Cr (r=-0.4, p=0.04) in ALL survivors. The present study shows impaired brain metabolism detected by MRS, reduced brain volumes and neurocognitive impairment in childhood ALL survivors treated with cranial radiotherapy and chemotherapy, despite complete hormone substitution. We also report an impairment of metabolites correlated to time since treatment and a progressive impairment in sustained attention, suggesting an accelerated aging in the irradiated brain. Following these survivors many decades, or throughout life, after treatment with cranial radiotherapy and chemotherapy is highly warranted for a broader understanding of long-term outcome in this patient group.
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Affiliation(s)
- Cecilia Follin
- Department of Endocrinology, Skåne University Hospital and IKVL, Lund University, Lund, Sweden.
| | - Eva Marie Erfurth
- Department of Endocrinology, Skåne University Hospital and IKVL, Lund University, Lund, Sweden
| | - Aki Johansson
- Department of Psychiatry, Clinical Sciences, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Department of Diagnostic Radiology, Skåne University Hospital and Clinical Sciences, Lund University, Sweden
| | - Pia C Sundgren
- Department of Diagnostic Radiology, Skåne University Hospital and Clinical Sciences, Lund University, Sweden
| | - Kai Österberg
- Department of Psychology, Lund University, Lund, Sweden
| | - Gabriella Spulber
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Mannfolk
- Department of Diagnostic Radiology, Skåne University Hospital and Clinical Sciences, Lund University, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Diagnostic Radiology, Skåne University Hospital and Clinical Sciences, Lund University, Sweden; Lund University Bioimaging Centre (LBIC), Lund University, Sweden
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de Blank PMK, Berman JI, Fisher MJ. Systemic Chemotherapy and White Matter Integrity in Tracts Associated with Cognition Among Children With Neurofibromatosis Type 1. Pediatr Blood Cancer 2016; 63:818-24. [PMID: 26757156 DOI: 10.1002/pbc.25896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with neurofibromatosis type 1 (NF1) are predisposed to both brain tumors and cognitive deficits. While changes in white matter integrity after multimodal therapy are associated with cognitive dysfunction, the effect of isolated chemotherapy in NF1 is unknown. To determine whether chemotherapy is associated with white matter microstructural changes, we examined diffusion tensor imaging (DTI) in NF1 subjects. PROCEDURE We reviewed DTI measures in tracts associated with cognition but free from tumor in 24 children with NF1-associated optic pathway gliomas unexposed to surgery or radiation. Twelve age-matched pairs were identified based on exposure to chemotherapy. A paired t-test was used to compare fractional anisotropy (FA) in tracts of interest between subjects with and without chemotherapy exposure. RESULTS On paired t-test, FA was significantly lower in the corpus callosum (P = 0.015) and cerebellothalamic (P = 0.038) tracts of subjects exposed to chemotherapy. There was no effect of age or time from chemotherapy on the difference between groups. In multivariable analysis, FA of these tracts was associated with chemotherapy exposure after adjusting for age, tumor location, and DTI acquisition. In longitudinal measures, FA decreased after chemotherapy exposure while FA increased with age in unexposed subjects. CONCLUSIONS Exposure to low-intensity chemotherapy in NF1 is associated with changes in white matter microstructure in tracts associated with cognition. Future studies should determine whether these changes are associated with cognitive decline. While chemotherapy may spare cognition relative to radiation and surgery, children with NF1 exposed to chemotherapy may benefit from early cognitive testing to allow for earlier intervention.
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Affiliation(s)
- Peter Matthew Kennedy de Blank
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey I Berman
- Department of Radiology, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Jay Fisher
- Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Tamnes CK, Zeller B, Amlien IK, Kanellopoulos A, Andersson S, Due-Tønnessen P, Ruud E, Walhovd KB, Fjell AM. Cortical surface area and thickness in adult survivors of pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2015; 62:1027-34. [PMID: 25597852 DOI: 10.1002/pbc.25386] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/12/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advances in the treatment of acute lymphoblastic leukemia (ALL) have led to great improvements in survival rates and outcomes, but there is concern about cognitive late effects. We aimed to determine whether ALL survivors have smaller cortical surface area and/or thickness, and test whether this is related to disease and treatment variables and self-reported executive functioning in everyday life. PROCEDURE Magnetic resonance imaging (MRI) scans from 130 adult long-term survivors of childhood ALL (age: 18-46 years; age at diagnosis: 0-16 years; years since diagnosis: 7-40) and 130 healthy controls were assessed to estimate and compare regional cortical surface area and thickness. Information on disease and treatment factors were obtained from patients' records, and executive functioning in survivors was measured using a validated questionnaire (BRIEF-A). RESULTS Smaller cortical surface area was observed in several regions in both cerebral hemispheres in ALL survivors. In these regions, mean surface area was 4.1-5.5% smaller in ALL survivors compared to healthy controls. In contrast, only one region showed lower cortical thickness in ALL survivors. There were no significant associations between cortical surface area/thickness in these regions and disease or treatment variables. In ALL survivors, smaller surface area in prefrontal regions, encompassing parts of the superior frontal gyri and the left anterior cingulate cortex, was associated with problems in executive functioning, specifically with emotional control and self-monitoring. CONCLUSIONS ALL survivors had smaller surface area in several cortical regions and smaller surface area in prefrontal regions was associated with reported problems in executive functioning.
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Affiliation(s)
- Christian K Tamnes
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway
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26
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Brain damage following prophylactic cranial irradiation in lung cancer survivors. Brain Imaging Behav 2015; 10:283-95. [DOI: 10.1007/s11682-015-9393-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Edelmann MN, Krull KR, Liu W, Glass JO, Ji Q, Ogg RJ, Sabin ND, Srivastava DK, Robison LL, Hudson MM, Reddick WE. Diffusion tensor imaging and neurocognition in survivors of childhood acute lymphoblastic leukaemia. Brain 2014; 137:2973-83. [PMID: 25125614 PMCID: PMC4208463 DOI: 10.1093/brain/awu230] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/13/2022] Open
Abstract
Survivors of childhood acute lymphoblastic leukaemia are at risk for neurocognitive impairment, though little information is available on its association with brain integrity, particularly for survivors treated without cranial radiation therapy. This study compares neurocognitive function and brain morphology in long-term adult survivors of childhood acute lymphoblastic leukaemia treated with chemotherapy alone (n = 36) to those treated with cranial radiation therapy (n = 39) and to healthy control subjects (n = 23). Mean (standard deviation) age at evaluation was 24.9 (3.6) years for the chemotherapy group and 26.7 (3.4) years for the cranial radiation therapy group, while time since diagnosis was 15.0 (1.7) and 23.9 (3.1) years, respectively. Brain grey and white matter volume and diffusion tensor imaging was compared between survivor groups and to 23 healthy controls with a mean (standard deviation) age of 23.1 (2.6) years. Survivors treated with chemotherapy alone had higher fractional anisotropy in fibre tracts within the left (P < 0.05), but not in the right, hemisphere when compared to controls. Survivors of acute lymphoblastic leukaemia, regardless of treatment, had a lower ratio of white matter to intracranial volume in frontal and temporal lobes (P < 0.05) compared with control subjects. Survivors of acute lymphoblastic leukaemia treated with chemotherapy alone performed worse in processing speed (P < 0.001), verbal selective reminding (P = 0.01), and academics (P < 0.05) compared to population norms and performed better than survivors treated with cranial radiation therapy on verbal selective reminding (P = 0.02), processing speed (P = 0.05) and memory span (P = 0.009). There were significant associations between neurocognitive performance and brain imaging, particularly for frontal and temporal white and grey matter volume. Survivors of acute lymphoblastic leukaemia treated with chemotherapy alone demonstrated significant long-term differences in neurocognitive function and altered neuroanatomical integrity. These results suggest substantial region-specific white matter alterations in survivors of acute lymphoblastic leukaemia possibly resulting in restricted radial diffusion due to the compaction of neuronal fibres.
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Affiliation(s)
- Michelle N Edelmann
- 1 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA
| | - Kevin R Krull
- 1 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA
| | - Wei Liu
- 2 Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 768, Memphis, TN 38105-3678, USA
| | - John O Glass
- 3 Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 220, Memphis, TN 38105-3678, USA
| | - Qing Ji
- 3 Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 220, Memphis, TN 38105-3678, USA
| | - Robert J Ogg
- 3 Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 220, Memphis, TN 38105-3678, USA
| | - Noah D Sabin
- 3 Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 220, Memphis, TN 38105-3678, USA
| | - Deo Kumar Srivastava
- 2 Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 768, Memphis, TN 38105-3678, USA
| | - Leslie L Robison
- 1 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA
| | - Melissa M Hudson
- 1 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA 4 Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA
| | - Wilburn E Reddick
- 3 Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 220, Memphis, TN 38105-3678, USA
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Diffusion tensor MRI of chemotherapy-induced cognitive impairment in non-CNS cancer patients: a review. Brain Imaging Behav 2014; 7:409-35. [PMID: 23329357 DOI: 10.1007/s11682-012-9220-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with non-central nervous system cancers often experience subtle cognitive deficits after treatment with cytotoxic agents. Therapy-induced structural changes to the brain could be one of the possible causes underlying these reported cognitive deficits. In this review, we evaluate the use of diffusion tensor imaging (DTI) for assessing possible therapy-induced changes in the microstructure of the cerebral white matter (WM) and provide a critical overview of the published DTI research on therapy-induced cognitive impairment. Both cross-sectional and longitudinal DTI studies have demonstrated abnormal microstructural properties in WM regions involved in cognition. These findings correlated with cognitive performance, suggesting that there is a link between reduced "WM integrity" and chemotherapy-induced impaired cognition. In this paper, we will also introduce the basics of diffusion tensor imaging and how it can be applied to evaluate effects of therapy on structural changes in cerebral WM. The review concludes with considerations and discussion regarding DTI data interpretation and possible future directions for investigating therapy-induced WM changes in cancer patients. This review article is part of a Special Issue entitled: Neuroimaging Studies of Cancer and Cancer Treatment.
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Kesler SR, Gugel M, Pritchard-Berman M, Lee C, Kutner E, Hosseini SH, Dahl G, Lacayo N. Altered resting state functional connectivity in young survivors of acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1295-9. [PMID: 24619953 PMCID: PMC4028071 DOI: 10.1002/pbc.25022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/14/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL) has been associated with long-term cognitive impairments in some patients. However, the neurobiologic mechanisms underlying these impairments, particularly in young survivors, are not well understood. This study aimed to examine intrinsic functional brain connectivity in pediatric ALL and its relationship with cognitive status. PROCEDURE We obtained resting state functional magnetic resonance imaging (rsfMRI) and cognitive testing data from 15 ALL survivors age 8-15 years and 14 matched healthy children. The ALL group had a history of intrathecal chemotherapy treatment but were off-therapy for at least 6 months at the time of enrollment. We used seed-based analyses to compare intrinsic functional brain network connectivity between the groups. We also explored correlations between connectivity and cognitive performance, demographic, medical, and treatment variables. RESULTS We demonstrated significantly reduced connectivity between bilateral hippocampus, left inferior occipital, left lingual gyrus, bilateral calcarine sulcus, and right amygdala in the ALL group compared to controls. The ALL group also showed regions of functional hyperconnectivity including right lingual gyrus, precuneus, bilateral superior occipital lobe, and right inferior occipital lobe. Functional hypoconnectivity was associated with reduced cognitive function as well as younger age at diagnosis in the ALL group. CONCLUSIONS This is the first study to demonstrate that intrinsic functional brain connectivity is disrupted in pediatric ALL following chemotherapy treatment. These results help explain cognitive dysfunction even when objective test performance is seemingly normal. Children diagnosed at a younger age may show increased vulnerability to altered functional brain connectivity.
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Affiliation(s)
- Shelli R. Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
,Correspondence to: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC5795, Stanford, CA 94305-5795.
| | - Meike Gugel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mika Pritchard-Berman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Clement Lee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Emily Kutner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - S.M. Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Gary Dahl
- Department of Pediatrics—Hematology/Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Norman Lacayo
- Department of Pediatrics—Hematology/Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
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30
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Nelson MB, Macey PM, Harper RM, Jacob E, Patel SK, Finlay JL, Nelson MD, Compton P. Structural brain alterations in children an average of 5 years after surgery and chemotherapy for brain tumors. J Neurooncol 2014; 119:317-26. [PMID: 24830985 DOI: 10.1007/s11060-014-1480-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/05/2014] [Indexed: 12/01/2022]
Abstract
Young children with brain tumors are often treated with high-dose chemotherapy after surgery to avoid brain tissue injury associated with irradiation. The effects of systemic chemotherapy on healthy brain tissue in this population, however, are unclear. Our objective was to compare gray and white matter integrity using MRI procedures in children with brain tumors (n = 7, mean age 8.3 years), treated with surgery and high-dose chemotherapy followed by autologous hematopoietic cell rescue (AuHCR) an average of 5.4 years earlier, to age- and gender-matched healthy controls (n = 9, mean age 9.3 years). Diffusion tensor imaging data were collected to evaluate tissue integrity throughout the brain, as measured by mean diffusivity (MD), a marker of glial, neuronal, and axonal status, and fractional anisotropy (FA), an index of axonal health. Individual MD and FA maps were calculated, normalized, smoothed, and compared between groups using analysis of covariance, with age and sex as covariates. Higher MD values, indicative of injury, emerged in patients compared with controls (p < .05, corrected for multiple comparisons), and were especially apparent in the central thalamus, external capsule, putamen, globus pallidus and pons. Reduced FA values in some regions did not reach significance after correction for multiple comparisons. Children treated with surgery and high-dose chemotherapy with AuHCR for brain tumors an average of 5.4 years earlier show alterations in white and gray matter in multiple brain areas distant from the tumor site, raising the possibility for long-term consequences of the tumor or treatment.
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Affiliation(s)
- Mary Baron Nelson
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #54, Los Angeles, CA, 90027, USA,
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31
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Genschaft M, Huebner T, Plessow F, Ikonomidou VN, Abolmaali N, Krone F, Hoffmann A, Holfeld E, Vorwerk P, Kramm C, Gruhn B, Koustenis E, Hernaiz-Driever P, Mandal R, Suttorp M, Hummel T, Ikonomidou C, Kirschbaum C, Smolka MN. Impact of chemotherapy for childhood leukemia on brain morphology and function. PLoS One 2013; 8:e78599. [PMID: 24265700 PMCID: PMC3827075 DOI: 10.1371/journal.pone.0078599] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/21/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Using multidisciplinary treatment modalities the majority of children with cancer can be cured but we are increasingly faced with therapy-related toxicities. We studied brain morphology and neurocognitive functions in adolescent and young adult survivors of childhood acute, low and standard risk lymphoblastic leukemia (ALL), which was successfully treated with chemotherapy. We expected that intravenous and intrathecal chemotherapy administered in childhood will affect grey matter structures, including hippocampus and olfactory bulbs, areas where postnatal neurogenesis is ongoing. METHODS We examined 27 ALL-survivors and 27 age-matched healthy controls, ages 15-22 years. ALL-survivors developed disease prior to their 11th birthday without central nervous system involvement, were treated with intrathecal and systemic chemotherapy and received no radiation. Volumes of grey, white matter and olfactory bulbs were measured on T1 and T2 magnetic resonance images manually, using FIRST (FMRIB's integrated Registration and Segmentation Tool) and voxel-based morphometry (VBM). Memory, executive functions, attention, intelligence and olfaction were assessed. RESULTS Mean volumes of left hippocampus, amygdala, thalamus and nucleus accumbens were smaller in the ALL group. VBM analysis revealed significantly smaller volumes of the left calcarine gyrus, both lingual gyri and the left precuneus. DTI data analysis provided no evidence for white matter pathology. Lower scores in hippocampus-dependent memory were measured in ALL-subjects, while lower figural memory correlated with smaller hippocampal volumes. INTERPRETATION Findings demonstrate that childhood ALL, treated with chemotherapy, is associated with smaller grey matter volumes of neocortical and subcortical grey matter and lower hippocampal memory performance in adolescence and adulthood.
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Affiliation(s)
- Marina Genschaft
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Huebner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Franziska Plessow
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Vasiliki N. Ikonomidou
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, United States of America
| | - Nasreddin Abolmaali
- Klinik und Poliklinik für Diagnostische Radiologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Krone
- Interdisciplinary Center for Smell and Taste, Dept. of ORL, Technische Universität Dresden, Dresden, Germany
| | - Andre Hoffmann
- Klinik für Kinder- und Jugendmedizin, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Elisabeth Holfeld
- Klinik für Kinder- und Jugendmedizin, Carl-Thieme-Klinikum Cottbus, Cottbus, Germany
| | - Peter Vorwerk
- Department of Pediatrics, University of Magdeburg, Magdeburg, Germany
| | - Christof Kramm
- University Children’s Hospital, University Medical Centre Halle, Halle, Germany
| | - Bernd Gruhn
- Department of Pediatrics, University of Jena, Jena, Germany
| | - Elisabeth Koustenis
- Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pablo Hernaiz-Driever
- Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rakesh Mandal
- Department of Pathology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Meinolf Suttorp
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, United States of America
| | - Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
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Edelmann MN, Krull KR. Brain volume and cognitive function in adult survivors of childhood acute lymphoblastic leukemia. Transl Pediatr 2013; 2:143-7. [PMID: 26835309 PMCID: PMC4729079 DOI: 10.3978/j.issn.2224-4336.2013.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The survival rate for childhood acute lymphoblastic leukemia (ALL) is greater than 80%. However, many of these survivors develop long-term chronic health conditions, with a relatively common late effect being neurocognitive dysfunction. Although neurocognitive impairments have decreased in frequency and severity as treatment has evolved, there is a subset of survivors in the current treatment era that are especially vulnerable to the neurotoxic effects of ALL and its treatment. Additionally, little is known about long-term brain development as survivors mature into adulthood. A recent study by Zeller et al. compared neurocognitive function and brain volume in 130 adult survivors of childhood ALL to 130 healthy adults matched on age and sex. They identified the caudate as particularly sensitive to the neurotoxic effects of chemotherapy. We discuss the implications and limitations of this study, including how their findings support the concept of individual vulnerability to ALL and its treatment.
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Affiliation(s)
- Michelle N Edelmann
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
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Schuitema I, Deprez S, Van Hecke W, Daams M, Uyttebroeck A, Sunaert S, Barkhof F, van Dulmen-den Broeder E, van der Pal HJ, van den Bos C, Veerman AJP, de Sonneville LMJ. Accelerated aging, decreased white matter integrity, and associated neuropsychological dysfunction 25 years after pediatric lymphoid malignancies. J Clin Oncol 2013; 31:3378-88. [PMID: 23960182 DOI: 10.1200/jco.2012.46.7050] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE CNS-directed chemotherapy (CT) and cranial radiotherapy (CRT) for childhood acute lymphoblastic leukemia or lymphoma have various neurotoxic properties. This study aimed to assess their impact on the maturing brain 20 to 30 years after diagnosis, providing a much stronger perspective on long-term quality of life than previous studies. PATIENTS AND METHODS Ninety-three patients treated between 1978 and 1990 at various intensities, with and without CRT, and 49 healthy controls were assessed with magnetic resonance diffusion tensor imaging (DTI) and neuropsychological tests. Differences in fractional anisotropy (FA)-a DTI measure describing white matter (WM) microstructure-were analyzed by using whole brain voxel-based analysis. RESULTS CRT-treated survivors demonstrated significantly decreased FA compared with controls in frontal, parietal, and temporal WM tracts. Trends for lower FA were seen in the CT-treated survivors. Decreases in FA correlated well with neuropsychological dysfunction. In contrast to the CT group and controls, the CRT group showed a steep decline of FA with age at assessment. Younger age at cranial irradiation and higher dosage were associated with worse outcome of WM integrity. CONCLUSION CRT-treated survivors show decreased WM integrity reflected by significantly decreased FA and associated neuropsychological dysfunction 25 years after treatment, although effects of CT alone seem mild. Accelerated aging of the brain and increased risk of early onset dementia are suspected after CRT, but not after CT.
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Affiliation(s)
- Ilse Schuitema
- Ilse Schuitema and Leo M.J. de Sonneville, Leiden University, Leiden; Ilse Schuitema, Marita Daams, Frederik Barkhof, Eline van Dulmen-den Broeder, and Anjo J.P. Veerman, Vrije Universiteit University Medical Center; Helena J. van der Pal and Cor van den Bos, Academic Medical Center, Amsterdam, the Netherlands; Sabine Deprez, Anne Uyttebroeck, and Stefan Sunaert, University Hospitals Leuven; Wim Van Hecke, icoMetrix, Leuven, Belgium
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Zeller B, Tamnes CK, Kanellopoulos A, Amlien IK, Andersson S, Due-Tønnessen P, Fjell AM, Walhovd KB, Westlye LT, Ruud E. Reduced neuroanatomic volumes in long-term survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 2013; 31:2078-85. [PMID: 23589559 DOI: 10.1200/jco.2012.47.4031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare regional brain volumes in adult long-term survivors of childhood acute lymphoblastic leukemia (ALL) and healthy controls. PATIENTS AND METHODS We investigated 130 survivors of childhood ALL diagnosed between 1970 and 2002 with magnetic resonance imaging (MRI) and neuropsychological testing at a median of 22.5 years after diagnosis. Morphometric analyses including whole-brain segmentation were performed using a validated automated procedure; 130 healthy adults served as controls. RESULTS Compared with healthy controls, ALL survivors showed significantly smaller volumes of cortical gray matter, cerebral white matter, amygdala, caudate, hippocampus, thalamus, and estimated intracranial volume. Effect sizes ranged from small to medium. The strongest effect was found for the caudate, which on average was 5.2% smaller in ALL survivors. Caudate volumes were also smaller when controlling for intracranial volume, suggesting a specific effect. Neither age at diagnosis nor treatment variables such as radiation therapy or drug dose had a major impact on neuroanatomic volumes. Neuropsychological assessment revealed reduced processing speed, executive function, and verbal learning/memory in survivors compared with controls but no difference in estimated general intellectual ability. In ALL survivors, but not in controls, neuropsychological test results correlated with volumes of cortical gray matter, caudate, and thalamus as well as intracranial volume. CONCLUSION Structural MRI of long-term survivors of childhood ALL demonstrated smaller volumes of multiple brain structures compared with healthy controls. Because of possible selection biases, these results must be interpreted with caution. Future studies are required to clarify the significance of these findings and the neurobiologic mechanisms involved.
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Affiliation(s)
- Bernward Zeller
- Department of Pediatric Medicine, Oslo University Hospital, Mailbox 4950 Nydalen, N-0424 Oslo, Norway.
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Abstract
PURPOSE OF REVIEW Modern cancer therapies have allowed for a dramatic increase in the survival rates in both children and adults. However, a frequent and unfortunate side-effect of cancer therapy is a long-term decline in neurocognitive function. Specifically, cranial radiation therapy markedly alters memory processes, while chemotherapeutic agents are correlated with deficits in attention, concentration, and speed of information processing. Here, we describe the putative cellular etiologies of cancer treatment-induced cognitive decline, with an emphasis on the role of neural stem and precursor cell dysfunction. RECENT FINDINGS New studies highlight the lasting effects of chemotherapy on memory, executive function, attention, and speed of information processing up to 20 years following chemotherapy. Cognitive decrements are associated with decreased white-matter integrity as well as alterations in stem cell function in humans and rodent models of cancer therapy. Genetic polymorphisms may underlie differential sensitivity of certain individuals to the neurological consequences of chemotherapy. Increasing data support the concept that disruption of normal neural stem and precursor cell function is an important causative factor for the cognitive deficits that result from cancer therapy in both children and adults. SUMMARY Further studies are needed to elucidate the role of chemotherapy on cell-intrinsic processes and cellular microenvironments. Further, the effects of the new generation of targeted molecular therapies on neural stem and progenitor cell function remains largely untested. Understanding the mechanisms behind cancer therapy-induced damage to neural stem and precursor cell populations will elucidate neuroprotective and cell replacement strategies aimed at preserving cognition after cancer therapy.
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Brinkman TM, Ullrich NJ, Zhang N, Green DM, Zeltzer LK, Lommel KM, Brouwers P, Srivastava DK, Jain N, Robison LL, Krull KR. Prevalence and predictors of prescription psychoactive medication use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2012; 7:104-14. [PMID: 23224753 DOI: 10.1007/s11764-012-0250-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/08/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Childhood cancer survivors are at risk for late effects which may be managed pharmacologically. The purposes of this study were to estimate and compare the prevalence of psychoactive medication use of adult survivors of childhood cancer and sibling controls, identify predictors of medication use in survivors, and investigate associations between psychoactive medications and health-related quality of life (HRQOL). METHODS Psychoactive medication use from 1994 to 2010 was evaluated in 10,378 adult survivors from the Childhood Cancer Survivor Study. A randomly selected subset of 3,206 siblings served as a comparison group. Multivariable logistic regression models were used to calculate odds ratios (OR) for baseline and new onset of self-reported psychoactive medication use and HRQOL. RESULTS Survivors were significantly more likely to report baseline (22 vs. 15 %, p < 0.001) and new onset (31 vs. 25 %, p < 0.001) psychoactive medication use compared to siblings, as well as use of multiple medications (p < 0.001). In multivariable models, controlling for pain and psychological distress, female survivors were significantly more likely to report baseline and new onset use of antidepressants (OR = 2.66, 95 % CI = 2.01-3.52; OR = 2.02, 95 % CI = 1.72-2.38, respectively) and multiple medications (OR = 1.80, 95 % CI = 1.48-2.19; OR = 1.77, 95 % CI = 1.48-2.13, respectively). Non-cranial radiation and amputation predicted incident use of analgesics >15 years following diagnosis. Antidepressants were associated with impairment across all domains of HRQOL, with the exception of physical function. CONCLUSIONS Prevalence of psychoactive medication use was higher among survivors for most medication classes, as was the use of multiple medications. Clinicians should be aware of the possible contribution of psychoactive medications to HRQOL. IMPLICATIONS FOR CANCER SURVIVORS Survivors of childhood cancer are more likely to be prescribed psychoactive medication than their sibling counterparts, though use of such medication does not appear to normalize quality of life. Survivors are encouraged to consider additional interventions, including psychosocial support and physical exercise.
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Affiliation(s)
- Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Hosseini SMH, Hoeft F, Kesler SR. GAT: a graph-theoretical analysis toolbox for analyzing between-group differences in large-scale structural and functional brain networks. PLoS One 2012; 7:e40709. [PMID: 22808240 PMCID: PMC3396592 DOI: 10.1371/journal.pone.0040709] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/12/2012] [Indexed: 11/18/2022] Open
Abstract
In recent years, graph theoretical analyses of neuroimaging data have increased our understanding of the organization of large-scale structural and functional brain networks. However, tools for pipeline application of graph theory for analyzing topology of brain networks is still lacking. In this report, we describe the development of a graph-analysis toolbox (GAT) that facilitates analysis and comparison of structural and functional network brain networks. GAT provides a graphical user interface (GUI) that facilitates construction and analysis of brain networks, comparison of regional and global topological properties between networks, analysis of network hub and modules, and analysis of resilience of the networks to random failure and targeted attacks. Area under a curve (AUC) and functional data analyses (FDA), in conjunction with permutation testing, is employed for testing the differences in network topologies; analyses that are less sensitive to the thresholding process. We demonstrated the capabilities of GAT by investigating the differences in the organization of regional gray-matter correlation networks in survivors of acute lymphoblastic leukemia (ALL) and healthy matched Controls (CON). The results revealed an alteration in small-world characteristics of the brain networks in the ALL survivors; an observation that confirm our hypothesis suggesting widespread neurobiological injury in ALL survivors. Along with demonstration of the capabilities of the GAT, this is the first report of altered large-scale structural brain networks in ALL survivors.
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Affiliation(s)
- S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America.
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Long-term neurocognitive outcomes in young adult survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2011; 33:450-8. [PMID: 21646917 DOI: 10.1097/mph.0b013e31820d86f2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five-year survival rates of childhood acute lymphoblastic leukemia (ALL) exceed 80% due to central nervous system-directed treatment including cranial radiation (CRT) and chemotherapy. However, these treatments are associated with neurocognitive compromise, the extent of which is correlated with higher dose and younger age at treatment. The aims of this study were to explore long-term neurocognitive outcomes in adult survivors of childhood ALL, and to identify measures sensitive to neurotoxicity in long-term survivors. We examined 24 adults who received 18 Gy CRT and chemotherapy for treatment of ALL between ages 2 and 15 years (median, 5.5). Time since diagnosis ranged from 6 to 26 years (median, 16.6). Younger age at diagnosis and longer time since diagnosis were associated with lower scores on a computerized battery that requires speed and accuracy across a number of domains (MicroCog), and other standardized neurocognitive tests. When compared with population norms, MicroCog indices were below average in survivors diagnosed with ALL before age 5, but only the reasoning/calculation index was below average in survivors diagnosed with ALL after age 5. In contrast, intelligence quotient (IQ) scores were average. In addition to confirming earlier studies showing that younger children are more vulnerable to treatment-related neurotoxicity, here we show that deficits exist many years post treatment even with a relatively lower dose of CRT, and that these deficits are especially evident on tasks involving rapid processing of information.
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Reddick WE, Conklin HM. Impact of acute lymphoblastic leukemia therapy on attention and working memory in children. Expert Rev Hematol 2011; 3:655-9. [PMID: 21091140 DOI: 10.1586/ehm.10.65] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kesler SR, Tanaka H, Koovakkattu D. Cognitive reserve and brain volumes in pediatric acute lymphoblastic leukemia. Brain Imaging Behav 2010; 4:256-69. [PMID: 20814845 PMCID: PMC3049995 DOI: 10.1007/s11682-010-9104-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acute lymphoblastic leukemia (ALL) is associated with long-term, progressive cognitive deficits and white matter injury. We measured global and regional white and gray matter as well as cognitive function and examined relationships between these variables and cognitive reserve, as indicated by maternal education level, in 28 young survivors of ALL and 31 healthy controls. Results indicated significantly reduced white matter volumes and cognitive testing scores in the ALL group compared to controls. Maternal education was inversely related to both global and regional white matter and directly related to gray matter in ALL and was directly related to both gray and white matter in controls, consistent with the cognitive reserve hypothesis. Cognitive performance was associated with different brain regions in ALL compared to controls. Maternal education was significantly positively correlated with working and verbal memory in ALL as well as processing speed and verbal memory in controls, improving models of cognitive outcome over medical and/or demographic predictors. Our findings suggest that cognitive reserve may be an important factor in brain injury and cognitive outcome in ALL. Additionally, children with ALL may experience some neural reorganization related to cognitive outcome.
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Affiliation(s)
- Shelli R Kesler
- Department of Psychiatry and Behavioral Sciences, Neuropsychology and Neurorehabilitation Laboratory, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
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Van Hecke W, Leemans A, De Backer S, Jeurissen B, Parizel PM, Sijbers J. Comparing isotropic and anisotropic smoothing for voxel-based DTI analyses: A simulation study. Hum Brain Mapp 2010; 31:98-114. [PMID: 19593775 DOI: 10.1002/hbm.20848] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Voxel-based analysis (VBA) methods are increasingly being used to compare diffusion tensor image (DTI) properties across different populations of subjects. Although VBA has many advantages, its results are highly dependent on several parameter settings, such as those from the coregistration technique applied to align the data, the smoothing kernel, the statistics, and the post-hoc analyses. In particular, to increase the signal-to-noise ratio and to mitigate the adverse effect of residual image misalignments, DTI data are often smoothed before VBA with an isotropic Gaussian kernel with a full width half maximum up to 16 x 16 x 16 mm(3). However, using isotropic smoothing kernels can significantly partial volume or voxel averaging artifacts, adversely affecting the true diffusion properties of the underlying fiber tissue. In this work, we compared VBA results between the isotropic and an anisotropic Gaussian filtering method using a simulated framework. Our results clearly demonstrate an increased sensitivity and specificity of detecting a predefined simulated pathology when the anisotropic smoothing kernel was used.
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Affiliation(s)
- Wim Van Hecke
- Department of Physics, University of Antwerp, Wilrijk, Belgium.
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Schmidt AT, Martin RB, Ozturk A, Kates WR, Wharam MD, Mahone EM, Horská A. Neuroimaging and neuropsychological follow-up study in a pediatric brain tumor patient treated with surgery and radiation. Neurocase 2010; 16:74-90. [PMID: 20391187 PMCID: PMC2911148 DOI: 10.1080/13554790903329133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intracranial tumors are the most common neoplasms of childhood, accounting for approximately 20% of all pediatric malignancies. Radiation therapy has led directly to significant increases in survival of children with certain types of intracranial tumors; however, given the aggressive nature of this therapy, children are at risk for exhibiting changes in brain structure, neuronal biochemistry, and neurocognitive functioning. In this case report, we present neuropsychological, magnetic resonance imaging, proton magnetic resonance spectroscopic imaging, and diffusion tensor imaging data for two adolescents (one patient with ependymal spinal cord tumor with intracranial metastases, and one healthy, typically developing control) from three time points as defined by the patient's radiation schedule (baseline before the patient's radiation therapy, 6 months following completion of the patient's radiation, and 27 months following the patient's radiation). In the patient, there were progressive decreases in gray and white matter volumes as well as early decreases in mean N-acetyl aspartate/choline (NAA/Cho) ratios and fractional anisotropy (FA) in regions with normal appearance on conventional MRI. At the last follow-up, NAA/Cho and FA tended to change in the direction to normal values in selected regions. At the same time, the patient had initial reduction in language and motor skills, followed by return to baseline, but later onset delay in visuospatial and visual perceptual skills. Results are discussed in terms of sensitivity of the four techniques to early and late effects of treatment, and avenues for future investigations.
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Affiliation(s)
- Adam T. Schmidt
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca B. Martin
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Arzu Ozturk
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy R. Kates
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry and Behavior Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Moody D. Wharam
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E. Mark Mahone
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alena Horská
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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